Urethroscopy

What is it?

You have two kidneys, which help to make urine. They lie deep in your back just in front of your lowest ribs.

The kidneys produce urine, which is drained through a tube called ureter (one for each kidney) in your bladder.

Your bladder is like a soft rubber balloon and drains through a fine tube (urethra), which has an opening into the penis or the front of the vagina. The tests you have had so far point to the urethra as the cause of your trouble.

It is necessary to look inside the urinary system to find out what is going on.

A special telescope is used to see, or sometimes to take X-rays. At the same time narrow parts can be widened, stones taken out, pieces of the lining taken out, and diseased parts burnt out as needed.

The operation

You can be given a general anaesthetic or you can be numbed from the waist down with an injection in the back.

The choice depends partly on which you prefer, and partly on what your surgeon or anaesthetist thinks is best.

Having a general anaesthetic means that you will be completely asleep during the operation.

Having an injection in the back means that you will be awake during the operation, you will feel that something is happening in the area you're being operated on, but will not be able to feel any pain from the waist down.

If the surgeon believes that he just needs to have a thorough look at your urethra (the tube that connects your bladder with you penis or the area in the front of your vagina) and or possibly your bladder and needs to take two to three pieces of tissue (biopsies) from the lining of the urethra or the bladder to clarify the problem, you might not need a general anaesthetic or an anaesthetic injection in the back.

As an alternative, the surgeon can flush some anaesthetic jelly into your urethra so that you will have only a minimal discomfort when he passes the telescope up into you. If you are awake for the operation, you will have your legs held up in stirrups. A nurse will chat to you during the operation.

A narrow tube is passed inside the penis in the male, (or into the front passage in the female), up into the bladder. The surgeon then slides a telescope and other instruments up the first tube. He then looks around, or takes X-rays, or operates as planned.

Finally all the equipment is taken out. Sometimes, after the operation, it is necessary to pass a fine plastic tube (a urine catheter) back up into the bladder. This will allow urine to drain freely into a bag (which is very useful especially if the urine has small clots of blood after the operation). It will also allow the doctors and the nurses to measure the amount of urine you produce after the operation and offer you some comfort by emptying your bladder after the operation when it may not be that easy for you.

Usually you can go home the same day. If there are any problems with the operation, you will need to stay longer. This sometimes happens if the operation is done under general anaesthetic or with an anaesthetic injection at the back or if the urine has some small amounts of blood after the operation. The doctors will let you know about this at the time.

Any alternatives?

Doing more X-rays, scans and other tests will not help find out what the trouble is. To find out, at this point, it is necessary to have a look inside the bladder and higher up towards the kidneys.

The simplest step is to slide telescopes and other instruments through the front passage into the bladder and beyond.

Bigger operations such as passing a telescope through the skin into the kidney are not needed at this stage. In the same way the treatment can be done by this route.

Open operations are not needed at this stage. If there is a growth in the bladder, burning or cutting the diseased lining away by this route is usually all that is needed. S

ometimes a drug treatment washed into the bladder is very helpful. X-ray treatment is usually held in reserve. If you do nothing you will not find out what the trouble is. The problem will steadily get worse. Also you will not get the benefit of early treatment and this can be extremely important particularly if it is something like a developing cancer which if diagnosed at an early stage could be treated.

Before the operation

Stop smoking and try to get your weight down if you are overweight. If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control.

Check that you have a relative or friend who can come with you to the hospital, take you home, and look after you after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to the hospital with you.

On the ward, you will be checked for past illnesses and will have special tests, ready for the operation. Please tell the nurses of any allergies to tablets, medicines or dressings.

You will have the operation explained to you and will be asked to fill in an operation consent form. Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.

Any tissues that are removed during the operation will be sent for tests to help plan the appropriate treatment. Any remaining tissue that is left over after the tests will be discarded.

Before the operation and as part of the consent process, you may be asked to give permission for any 'left over' pieces to be used for medical research that has been approved by the hospital. It is entirely up to you to allow this or not.

Many hospitals now run special preadmission clinics, where you visit a week or so before the operation, where these checks will be made.

After – in hospital

You may have a fine, rubber tube (catheter) passing into the bladder through the front passage. This is to help you to pass urine freely which can be a bit difficult after an operation like this. Sometimes the catheter needs to be flushed out to keep the urine flowing properly.

You may be given oxygen from a face mask for a few hours if you have had chest problems in the past, if you are a smoker or you are obese.

There may be some slight discomfort where the instruments have been. You will not normally need painkillers. The feeling goes away after a day or two. However, if you feel that you can't tolerate the discomfort, you can ask for help. Painkiller tablets can usually help but very rarely you will need an injection.

A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions, drive a car, use machinery, or even boil a kettle during this time.

If there is no catheter, you should be able to pass urine before you leave hospital. If you cannot pass urine, let the doctors and the nurses know. If there is a catheter, the urine drains out automatically. The catheter will be taken out when the urine is clear and when it is safe to do so. After that you will be checked to see that you are passing urine properly.

It is a good idea to drink an extra pint of water each day more than you usually do. Do this for a week after the operation. This will help to clean the urine.

You will be given an appointment for the outpatient department, or you will get a date for any repeat operation. Some hospitals arrange a check-up about one month after you leave hospital. By then the results of the biopsies should be ready. Others leave check-ups to the general practitioner. The nurses will advise about sick notes, certificates etc.

After – at home

You may feel tired for a day or two after the operation. You should not drive for 24 hours after the anaesthetic.

You can start sexual relations within two to three days of the operation as long as you feel comfortable.

You should be able to go back to work one to two days after leaving hospital.

Possible complications

If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs.

The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

If you have an anaesthetic injection in the back, there is a very small chance of a blood clot forming on top of your spine which can lead to a feeling of numbness or pins and needles in your legs. Most of time the clot dissolves on its own and this solves the problem.

Extremely rarely, the injections can cause permanent damage to your spine. Complications are rare. If you think that all is not well, please let the doctors or the nurses know.

Chest infections may arise, particularly in smokers or obese patients. Do not smoke.

Getting out of bed as quickly as possible, being as mobile as possible and co-operating with the physiotherapists to clear the air passages is important in preventing a chest infection.

Sometimes there is blood in the urine and if the doctors expect this a catheter is usually put in at the time of the operation. It may take some days to clear. You will need to stay in hospital until it gets better.

Sometimes you can have infection which is either localised in your urine stream or gets into the bloodstream. If the infection is only in your urine, you will be given antibiotics tablets to treat it.

Although rare, if the infection is much more serious and spreads through your bloodstream, you will need to remain in hospital so doctors can give you intravenous antibiotics (through a vein in one of your arms).

Extremely rarely (especially if many biopsies are taken or there is a lot of burning) the telescope or the other instruments used during the operation can create a hole (perforation) or an extensive scratch in the lining of the urethra or the bladder. This problem is usually corrected by putting a catheter back in for one or two weeks to decompress the bladder and drain the urine until the hole or the scratch has healed. Only in extreme circumstances will you need another operation to fix the problem.

General advice

The operation is mostly simple, straightforward and quick. You should be prepared to stay in hospital longer if needed.

These notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little.

If you have any queries or problems, please ask the doctors or nurses.

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